{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T03:16:10Z","timestamp":1794280570176,"version":"4.9.0"},"reference-count":36,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"unspecified","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004829","name":"Science and Technology Department of Sichuan Province","doi-asserted-by":"publisher","award":["2025ZNSFSC1570"],"award-info":[{"award-number":["2025ZNSFSC1570"]}],"id":[{"id":"10.13039\/501100004829","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Sichuan Provincial Nursing Association","award":["H22024"],"award-info":[{"award-number":["H22024"]}]},{"DOI":"10.13039\/501100019971","name":"Luzhou Science and Technology Bureau","doi-asserted-by":"publisher","award":["2022-SYE-54"],"award-info":[{"award-number":["2022-SYE-54"]}],"id":[{"id":"10.13039\/501100019971","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Chinese Nursing Association","award":["ZHKYQ202114"],"award-info":[{"award-number":["ZHKYQ202114"]}]},{"DOI":"10.13039\/501100020207","name":"Sichuan Provincial Health Commission","doi-asserted-by":"crossref","award":["20PJ134"],"award-info":[{"award-number":["20PJ134"]}],"id":[{"id":"10.13039\/501100020207","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,3,14]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Effective chronic obstructive pulmonary disease (COPD) interventions require intensive and repetitive exercises, yet their monotonous nature can reduce adherence. Innovative rehabilitation devices that are safe, user-friendly, engaging and cost-effective are crucial. This study introduces a digital gamification-based approach to pursed lip breathing (PLB) exercises, guided by the Behaviour Change Wheel (BCW) framework. The digital platform transforms traditional PLB into an interactive and enjoyable experience, enhancing motivation and adherence. Using a pre-post study design, this feasibility trial aims to assess the safety, feasibility and acceptability of the digital gamification PLB intervention protocol driven by the BCW framework installed on WeChat (DT-PLB) for home-based COPD management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The methodology of this study is divided into two phases. Phase 1 refers to the development of the DT-PLB system based on research evidence, behavioural analysis from the insight of the BCW and stakeholders\u2019 perspectives, and phase 2 points to present the pre-post trial design for the DT-PLB system consisting of five smartphone-based software interface modules: Ranking, Report, Daily PLB Tasks, Social Community and Mine. Eligible patients with COPD will be recruited from a university hospital in Sichuan Province, Mainland China. The DT-PLB will be conducted in non-hospital settings for patients with COPD for 10\u2009min per session, three times a day on a daily basis for 8\u2009weeks. Data collection will be conducted at two time points: baseline and post-intervention.<\/jats:p>\n                    <jats:p>Demographic data (eg, age, gender and marital status) will be collected only at baseline. The primary outcome measures in this study will be a series of feasibility outcomes involving participant recruitment and completion of the DT-PLB intervention. Additionally, several clinical outcomes in terms of the effects of the DT-PLB intervention on dyspnoea, exercise capability, quality of life, and pulmonary function index will be evaluated as secondary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has received Manchester Metropolitan University ethical approval (REC reference 56631) and the Affiliated Hospital of Southwest Medical University ethical approval (REC reference KY2023105). The findings from DT-PLB will be disseminated widely through peer-reviewed publications, scientific conferences and workshops. If successful, DT-PLB will be directly applied to the Affiliated Hospital of Southwest Medical University to manage PLB exercises.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06063733\">NCT06063733<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-090832","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T04:02:04Z","timestamp":1743134524000},"page":"e090832","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Digital gamification-based pursed lip breathing exercises driven by Behaviour Change Wheel in patients with COPD: a feasibility trial protocol using pre-post study design"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct06063733","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5862-0419","authenticated-orcid":false,"given":"Houqiang","family":"Huang","sequence":"first","affiliation":[{"name":"Nursing Department, The Affiliated Hospital of Southwest Medical University, Luzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fake","family":"Liu","sequence":"additional","affiliation":[{"name":"The People\u2019s Hospital of Jiang\u2019an Country, Yibin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohannad","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Manchester Metropolitan University, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Watson","sequence":"additional","affiliation":[{"name":"Southwest Medical University, Luzhou, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hayter","sequence":"additional","affiliation":[{"name":"Manchester Metropolitan University, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihui","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"2025121404282702000_15.3.e090832.1","unstructured":"Agusti ABR , Chen RC , Criner G . Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2020 report. GOLD Committees; 2020.1\u2013125."},{"key":"2025121404282702000_15.3.e090832.2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202102-146ST"},{"key":"2025121404282702000_15.3.e090832.3","doi-asserted-by":"crossref","DOI":"10.1111\/opn.12627","article-title":"Development and Validation of an Evidence-Based Home Pursed Lip Breathing Protocol for Improving Health Outcomes in Patients With Chronic Obstructive Pulmonary Disease","volume":"19","author":"Huang","year":"2024","journal-title":"Int J Older People Nurs"},{"key":"2025121404282702000_15.3.e090832.4","doi-asserted-by":"crossref","first-page":"488","DOI":"10.71000\/m66c1140","article-title":"Impact of diaphragmatic breathing with purse lip breathing versus pursed-lip breathing alone on dyspnea and exercise capacity among copd patients","volume":"2","author":"Riaz","year":"2024","journal-title":"IJHR"},{"key":"2025121404282702000_15.3.e090832.5","article-title":"Breathing exercises for chronic obstructive pulmonary disease","volume":"10","author":"Holland","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121404282702000_15.3.e090832.6","first-page":"695","article-title":"A review on adherence to respiratory exercise in patients with moderate to severe COPD","volume":"34","author":"Zhou","year":"2019","journal-title":"J Nurs Train"},{"key":"2025121404282702000_15.3.e090832.7","unstructured":"Chen L . The impact of respiratory training on exercise capacity in patients with COPD. Southern Medical University, 2017."},{"key":"2025121404282702000_15.3.e090832.8","unstructured":"Statistics OoN . Internet access \u2013 households and individuals, Great Britain: 2020. London, UK, 2021."},{"key":"2025121404282702000_15.3.e090832.9","unstructured":"Center CINI . Statistical report on the development of internet in China. 2022."},{"key":"2025121404282702000_15.3.e090832.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-012447","article-title":"Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps","volume":"6","author":"Edwards","year":"2016","journal-title":"BMJ Open"},{"key":"2025121404282702000_15.3.e090832.11","doi-asserted-by":"crossref","first-page":"103657","DOI":"10.1016\/j.actpsy.2022.103657","article-title":"Gamification for behavior change: A scientometric review","volume":"228","author":"Bassanelli","year":"2022","journal-title":"Acta Psychol (Amst)"},{"key":"2025121404282702000_15.3.e090832.12","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18073550","article-title":"Effects of Gamification on Behavioral Change in Education: A Meta-Analysis","volume":"18","author":"Kim","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025121404282702000_15.3.e090832.13","doi-asserted-by":"crossref","unstructured":"Mishlanov V , Chuchalin A , Chereshnev V , et al . Scope and new horizons for implementation of m-Health\/e-Health services in pulmonology in 2019. Monaldi Arch Chest Dis 2019;89. doi:10.4081\/monaldi.2019.1112","DOI":"10.4081\/monaldi.2019.1112"},{"key":"2025121404282702000_15.3.e090832.14","doi-asserted-by":"crossref","DOI":"10.2196\/46358","article-title":"Effects of Serious Games for Patients With Chronic Obstructive Pulmonary Disease: Systematic Literature Review","volume":"11","author":"Huang","year":"2023","journal-title":"JMIR Serious Games"},{"key":"2025121404282702000_15.3.e090832.15","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-42"},{"key":"2025121404282702000_15.3.e090832.16","unstructured":"Agusti A , Beasley R , Celli B , et al . Global initiative for chronic obstructive lung disease. Gold Science Committee; 2022.1\u201353."},{"key":"2025121404282702000_15.3.e090832.17","doi-asserted-by":"crossref","first-page":"3719","DOI":"10.2147\/COPD.S178149","article-title":"Validation of clinical control in COPD as a new tool for optimizing treatment","volume":"13","author":"Soler-Catalu\u00f1a","year":"2018","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2025121404282702000_15.3.e090832.18","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-10-1"},{"key":"2025121404282702000_15.3.e090832.19","doi-asserted-by":"publisher","DOI":"10.1002\/pst.185"},{"key":"2025121404282702000_15.3.e090832.20","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.4055","article-title":"The person-based approach to intervention development: application to digital health-related behavior change interventions","volume":"17","author":"Yardley","year":"2015","journal-title":"J Med Internet Res"},{"key":"2025121404282702000_15.3.e090832.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide","volume":"348","author":"Hoffmann","year":"2014","journal-title":"BMJ"},{"key":"2025121404282702000_15.3.e090832.22","doi-asserted-by":"crossref","unstructured":"Prowse PT . A Meta-Evaluation: The Role of Treatment Fidelity within Psychosocial Interventions during the Last Decade. J Psychiatry 2015;18. doi:10.4172\/Psychiatry.1000251","DOI":"10.4172\/Psychiatry.1000251"},{"key":"2025121404282702000_15.3.e090832.23","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-141-10-200411160-00009"},{"key":"2025121404282702000_15.3.e090832.24","unstructured":"Gimpel H , Schmied F . Risks and side effects of digitalization: a multi-level taxonomy of the adverse effects of using digital technologies and media. AISeL 2019."},{"key":"2025121404282702000_15.3.e090832.25","unstructured":"Bergin ADG , Valentine AZ , Rennick Egglestone S , et al . How are adverse events identified and categorised in trials of digital mental health interventions? A narrative scoping review of trials in the ISRCTN registry. JMIR Ment Health 2023."},{"key":"2025121404282702000_15.3.e090832.26","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.5082","article-title":"Efficacy and External Validity of Electronic and Mobile Phone-Based Interventions Promoting Vegetable Intake in Young Adults: Systematic Review and Meta-Analysis","volume":"18","author":"Nour","year":"2016","journal-title":"J Med Internet Res"},{"key":"2025121404282702000_15.3.e090832.27","first-page":"577","article-title":"The System Usability Scale: Past, Present, and Future","volume":"34","author":"Lewis","year":"2018","journal-title":"Int J Hum Comput Int"},{"key":"2025121404282702000_15.3.e090832.28","first-page":"953","article-title":"Chinese System Usability Scale: Translation, Revision, Psychological Measurement","volume":"36","author":"Wang","year":"2020","journal-title":"Int J Hum Comput Int"},{"key":"2025121404282702000_15.3.e090832.29","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.2147\/COPD.S82408","article-title":"Modified Medical Research Council scale vs Baseline Dyspnea Index to evaluate dyspnea in chronic obstructive pulmonary disease","volume":"10","author":"Perez","year":"2015","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2025121404282702000_15.3.e090832.30","first-page":"303","article-title":"Effects of exercise program based on somatosensory interactive games in elderly patients with stable COPD","volume":"27","author":"Zhou","year":"2021","journal-title":"Chin J Mod Nurs"},{"key":"2025121404282702000_15.3.e090832.31","doi-asserted-by":"crossref","DOI":"10.1177\/2050312120965336","article-title":"Reliability and validity of the multidimensional dyspnea profile in hospitalized Chinese patients with respiratory diseases","volume":"9","author":"Chen","year":"2021","journal-title":"SAGE Open Med"},{"key":"2025121404282702000_15.3.e090832.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2019.10.014"},{"key":"2025121404282702000_15.3.e090832.33","first-page":"783","article-title":"The six-minute walk test","volume":"48","author":"Enright","year":"2003","journal-title":"Respir Care"},{"key":"2025121404282702000_15.3.e090832.34","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00025214"},{"key":"2025121404282702000_15.3.e090832.35","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00102509"},{"key":"2025121404282702000_15.3.e090832.36","unstructured":"Hyatt RE , Scanlon PD , Nakamura M . Interpretation of pulmonary function tests. Lippincott Williams & Wilkins, 2014."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-090832","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T12:28:37Z","timestamp":1765715317000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-090832"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,27]]},"published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1136\/bmjopen-2024-090832"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-090832","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2024-090832.supp1","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2024-090832.supp2","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2024-090832.supp3","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2024-090832.supp4","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2024-090832.supp5","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2024-090832.supp6","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}